This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bhandari, A. K. Articles by Winkle, R. Search for Related Content PubMed PubMed Citation Articles by Bhandari, A. K. Articles by Winkle, R.

Circulation, Vol 70, 1018-1023, Copyright © 1984 by American Heart Association

ARTICLES

Efficacy of left cardiac sympathectomy in the treatment of patients with the long QT syndrome

AK Bhandari, MM Scheinman, F Morady, J Svinarich, J Mason and R Winkle

Ten patients with the long QT syndrome and recurrent syncope and/or cardiac arrest caused by ventricular arrhythmias underwent left stellate (one patient) or left cervicothoracic sympathectomy (nine patients) after failing to respond to high-dose beta-blocker therapy. The syndrome was familial in four and idiopathic in six. All patients had a prolonged resting QT interval (548 +/- 51 msec, mean +/- SD) and corrected QT interval (QTc) (556 +/- 43 msec). After sympathectomy the mean QTc shortened significantly from 556 +/- 43 to 508 +/- 65 msec (p less than .05) but the QTc remained abnormal in all but one patient. Over a mean follow-up period of 38.6 +/- 19 months, eight patients developed recurrent symptoms that included cardiac arrest in three (one fatal, two nonfatal), syncope in four, and presyncope in six. The addition of beta-blockers was ineffective in suppressing the recurrent symptoms. The control of symptoms required more extensive sympathectomy (three patients), chronic atrial pacing (three patients), and implantation of an automatic internal defibrillator (one patient). Only one patient has remained asymptomatic without drug or pacemaker therapy. In conclusion, left cervicothoracic sympathectomy proved inadequate for long-term control of symptoms in most patients with the long QT syndrome. These patients usually required concomitant drugs, more extensive surgery, or long-term cardiac pacing for symptomatic relief.

This article has been cited by other articles:

				G. M. Vincent Genotyping Has a Minor Role in Selecting Therapy for Congenital Long-QT Syndromes at Present Circ Arrhythm Electrophysiol, August 1, 2008; 1(3): 227 - 233. [Full Text] [PDF]

				E. Marijon, N. Combes, J. P. Albenque, J. R. Kapoor, and D. M. Roden Long-QT syndrome. N. Engl. J. Med., May 1, 2008; 358(18): 1967 - 1968. [Full Text] [PDF]

				P. J. Schwartz, S. G. Priori, M. Cerrone, C. Spazzolini, A. Odero, C. Napolitano, R. Bloise, G. M. De Ferrari, C. Klersy, A. J. Moss, et al. Left Cardiac Sympathetic Denervation in the Management of High-Risk Patients Affected by the Long-QT Syndrome Circulation, April 20, 2004; 109(15): 1826 - 1833. [Abstract] [Full Text] [PDF]

				P. Abraham, J. Berthelot, J. Victor, J.-L. Saumet, J. Picquet, and B. Enon Holter changes resulting from right-sided and bilateral infrastellate upper thoracic sympathectomy Ann. Thorac. Surg., December 1, 2002; 74(6): 2076 - 2081. [Abstract] [Full Text] [PDF]

				S Viskin, R Fish, D Zeltser, B Belhassen, K Heller, D Brosh, S Laniado, and H V Barron Arrhythmias in the congenital long QT syndrome: how often is torsade de pointes pause dependent? Heart, June 1, 2000; 83(6): 661 - 666. [Abstract] [Full Text]

				P. C. Nalos, M. R. Myers, E. S. Gang, T. Peter, and W. J. Mandel Analytic Reviews: Electrophysiologic Testing in the Intensive Care Unit J Intensive Care Med, September 1, 1987; 2(5): 241 - 259. [Abstract] [PDF]